KEY FACTS:

The annual death toll of more than five million could rise to more than eight million by 2030 unless urgent action is taken to control the tobacco epidemic.

More than 80% of the world's one billion smokers live in low- and middle-income countries.

Total consumption of tobacco products is increasing globally, though it is decreasing in some high-income and upper middle-income countries.

Leading cause of death, illness and impoverishment

Tobacco use is one of the biggest public health threats the world has ever faced. It kills more than five million people a year – an average of one person every six seconds – and accounts for one in 10 adult deaths. Up to half of current users will eventually die of a tobacco-related disease.

More than 80% of the one billion smokers worldwide live in low- and middle-income countries, where the burden of tobacco-related illness and death is heaviest.

Tobacco users who die prematurely deprive their families of income, raise the cost of health care and hinder economic development.

In some countries, children from poor households are frequently employed in tobacco farming to provide family income. These children are especially vulnerable to "green tobacco sickness", which is caused by the nicotine that is absorbed through the skin from the handling of wet tobacco leaves.

Gradual killer:

Because there is a lag of several years between when people start using tobacco and when their health suffers, the epidemic of tobacco-related disease and death has just begun.

Tobacco caused 100 million deaths in the 20th century. If current trends continue, it will cause up to one billion deaths in the 21st century.

Unchecked, tobacco-related deaths will increase to more than eight million per year by 2030. More than 80% of those deaths will be in low- and middle-income countries.

Surveillance is key:

Good monitoring tracks the size and character of the epidemic and indicates how best to tailor policies. Two-thirds of countries – more than four in five of them low- and middle-income– do not have even minimal information about tobacco use.

Second-hand smoke kills:

Second-hand smoke is the smoke that fills restaurants, offices or other enclosed spaces when people burn tobacco products such as cigarettes, bidis and water pipes. There is no safe level of second-hand tobacco smoke.

Every person should be able to breathe smoke-free air. Smoke-free laws protect the health of non-smokers, are popular, do not harm business and encourage smokers to quit.1

Only 5.4% of people are protected by comprehensive national smoke-free laws.

In 2008, the number of people protected from second-hand smoke increased by 74% to 362 million from 208 million in 2007.

Of the 100 most populous cities, 22 are smoke free.

Almost half of children regularly breathe air polluted by tobacco smoke.

Over 40% of children have at least one smoking parent.

Second-hand smoke causes 600,000 premature deaths per year.

In 2004, children accounted for 28% of the deaths attributable to second-hand smoke.

There are more than 4,000 chemicals in tobacco smoke, of which at least 250 are known to be harmful and more than 50 are known to cause cancer.

Studies show that few people understand the specific health risks of tobacco use. For example, a 2009 survey in
China
revealed that only 37% of smokers knew that smoking causes coronary heart disease and only 17% knew that it causes stroke.2

Among smokers who are aware of the dangers of tobacco, most want to quit. Counselling and medication can more than double the chance that a smoker who tries to quit will succeed.

National comprehensive health-care services supporting cessation are available only in 17 countries, representing 8.2% of the world's population.

There is no cessation assistance in 29% of low-income countries and 8% of middle-income countries.

Picture warnings work:

Hard-hitting anti-tobacco advertisements and graphic pack warnings – especially those that include pictures – reduce the number of children who begin smoking and increase the number of smokers who quit.

Studies carried out after the implementation of pictorial package warnings in
Brazil
,
Canada
,
Singapore
and
Thailand
consistently show that pictorial warnings significantly increase people's awareness of the harms of tobacco use.

Although pictures are more powerful deterrents than words on tobacco packaging warnings, only 19 countries, representing 24% of the world’s population,mandate pictorial warnings.

Just 15 countries, representing 7.6% of the world's population, meet the highest standards for pictorial warnings, which include that they be in colour and cover at least half of both the front and back of cigarette packs.

Only 26 countries, representing 8.8% of the world’s population, have comprehensive national bans on tobacco advertising, promotion and sponsorship.

27% of the world's population live in countries that do not ban free distribution of tobacco products.

Taxes discourage tobacco use:

Tobacco taxes are the most effective way to reduce tobacco use, especially among young people and poor people. A tax increase that increases tobacco prices by 10% decreases tobacco consumption by about 4% in high-income countries and by up to 8% in low- and middle-income countries.

Only 21 countries, representing 6.2% of the world's population, have tobacco tax rates greater than 75% of the retail price.

In countries with available information, tobacco tax revenues are 173 times higher than spending on tobacco control.

WHO Response:

WHO is committed to fight the global tobacco epidemic. The WHO Framework Convention on Tobacco Control entered into force in February 2005. Since then, it has become one of the most widely embraced treaties in the history of the United Nations with nearly 170 Parties covering 86% of the world's population. The WHO Framework Convention is WHO's most important tobacco control tool and a milestone in the promotion of public health. It is an evidence-based treaty that reaffirms the right of people to the highest standard of health, provides legal dimensions for international health cooperation and sets high standards for compliance.

In 2008, WHO introduced the MPOWER package of tobacco control measures to further counter the epidemic and to help countries to implement the WHO Framework Convention. The six MPOWER measures are: